Go to the Federal Communications Commission homepage at www.fcc.gov

FCC Form 399: Reimbursement Request

Approved by OMB 3060-1178
Go to the Federal Communications Commission homepage at www.fcc.gov

(REFERENCE COPY - Not for submission) FCC Form 399: Reimbursement Request

Facility ID:
73375
Service:
DTV
Call Sign:
WOLF-TV
Channel:
22 (UHF)
File Number:
0000028821
FRN:
0015435357
Date Submitted:
02/08/2022

Applicant Information

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Applicant Name, Type, and Contact Information

Applicant Address Phone Email Applicant Type

NEW AGE MEDIA OF PENNSYLVANIA LICENSE, LLC

Doing Business As: NEW AGE MEDIA OF PENNSYLVANIA LICENSE, LLC

1181 HIGHWAY 315

WILKES-BARRE, PA 18702

United States

+1 (570) 970-5600 jparente1966@gmail.com Limited Liability Company

Reimbursement Contact Information

Reimbursement Contact Name and Information

Applicant Address Phone Email

[Confidential]

 

 

 


Preparer Contact Information

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Preparer Contact Name and Information

Applicant Address Phone Email

Paul A. Cicelski , Esq .

Lerman Senter PLLC

2001 L Street NW

Suite 400

Washington, DC 20036

United States

+1 (202) 416-6756 pcicelski@lermansenter.com

Broadcaster Information and Transition Plan

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Question Response
Will the station be sharing equipment with another broadcast television station or stations (e.g., a shared antenna, co-location on a tower, use of the same transmitter room, multiple transmitters feeding a combiner, etc.)? If yes, enter the facility ID's of the other stations and click 'prefill' to download those stations' licensing information. No
Briefly describe transition plan See Exhibit A.

Transmitters

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Section Question Response
Transmitter Related Expenses Do you have transmitter related expenses? Yes

Auxiliary Transmitter

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Add Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Lease New
Use Auxiliary (Backup)
Description of Use Backup
Ownership Leased
Owner Sinclair Broadcast Group
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model CTS II
Year 2005
Type Inductive Output Tube
IOT Power Type Single
Power Capacity 30 kW

Auxiliary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Auxiliary (Backup)
Change Type Lease New
Is this a request for upgraded equipment? No
Manufacturer
Model THU9evo/20
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 31 kW
Justification for New Transmitter The current transmitter cannot be retuned because the manufacturer is no longer in business.

Auxiliary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) No
Transformer (480V) No
Power N/A
Rigid Conduit and Wiring Yes
Size 2 inches
Length 400.0 feet
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Auxiliary Transmitter

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Other Transmitter Cost Not Listed

Information not provided.

Primary Transmitter

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Existing Transmitter Information

Section Question Response
Existing Transmitter Description Type of change Purchase New
Use Primary (Main)
Description of Use N/A
Ownership Leased
Owner Sinclair Broadcast Group
Site N/A
Is this transmitter currently shared with another station? No
Is this transmitter currently in operating condition? Yes
Existing Transmitter Manufacturer and Type Manufacturer
Model CTS II
Year 2005
Type Inductive Output Tube
IOT Power Type Single
Power Capacity 30 kW

Primary Transmitter

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New Transmitter Costs

Section Question Response
New Transmitter Use Primary (Main)
Change Type Purchase New
Is this a request for upgraded equipment? No
Manufacturer
Model THU9evo/20
Transmitter Type Solid State
Solid State Cooling Liquid Cooled
Solid State Power capacity 31 kW
Justification for New Transmitter The current transmitter cannot be re-tuned.

Primary Transmitter

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Other Transmitter Costs

Section Question Response
Electrical Service Service Entrance (3 phases 800A 208V) No
Switchgear (industrial 800 amp) Yes
Transformer (480V) Yes
Power 300 kVA
Rigid Conduit and Wiring No
Size N/A
Length N/A
Other Electrical Service No
Description N/A
HVAC Service Does the replacement transmitter require HVAC Service? No
Type N/A
Size N/A
Other Size N/A
Transmitter Building Addition/Modification or Leasehold Improvement Does the Transmitter Building require an addition, modification, other leashold improvement? No
Size N/A
Channel 14 Costs Is an RF Consulting Engineer needed? N/A
Is a channel 14 Mask Filer needed? N/A
Is additional field engineering time needed? N/A
Number of Days N/A

Primary Transmitter

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Other Transmitter Cost Not Listed

Name Description

Transmitter Building

Transmitter Building

Additional Equipment

Additional Equipment

UHF inside RF system including switching

UHF inside RF system including switching

Installation Materials

Installation Materials

Antennas

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Section Question Response
Antenna Related Expenses Do you have antenna related expenses? Yes

Primary Antenna

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Existing Antenna Information

Section Question Response
Existing Antenna Description Type of change Lease New
Antenna Use Primary (Main)
Description of Use N/A
Ownership Leased
Owner Sinclair Broadcast Group
Site N/A
Is the existing antenna shared with another station or stations? No
Is the existing antenna directional? No
Is antenna in operating condition? Yes
Is antenna located on or in close proximity to an antenna farm? Yes
Existing Antenna Manufacturer and Type Class Full Power
Mounting Side Mount
Antenna position in stack Not in Stack
Polarization Horizontal
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels N/A
Design power capacity in use N/A
Lower Limit N/A
Upper Limit N/A
Other Antenna Type N/A
ERP: 420.0 kW
Manufacturer
Model TFU-15DSB (C)
Year 2016

Primary Antenna

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New Antenna Costs

Section Question Response
New Antenna Description Use Primary (Main)
Description of Use N/A
Change Type Lease New
Is this a request for upgraded equipment? Yes
Ownership Leased
Owner SINCLAIR BROADCAST GROUP
Is antenna shared? No
Is antenna directional? No
Will antenna be located on or in close proximity to an antenna farm? Yes
New Antenna Manufacturer and Types Class Full Power
Mounting Top Mount
Antenna position in stack Not in Stack
Polarization Elliptical
Type Slotted Coaxial
Number of Stations Supported N/A
Number of Panels/Bays N/A
Lower Limit N/A
Upper Limit N/A
Design power capacity in use N/A
Other Antenna Type N/A
ERP: 262.0 kW
Manufacturer
Model TFU-18GTH/VP-R 04
Year 2017
Justification for New Antenna Current antenna is a single channel antenna that cannot be used for the new post-auction channel.

Primary Antenna

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Other Antenna Costs

Section Question Response
Combiner for Shared Antenna Do you need a Combiner for a Shared Antenna?
Type
Number of channels supported N/A
Frequencies of channels supported N/A
Frequency N/A
Do you need a combiner output splitter/switcher for dual feed lines? N/A
Elbow Complex Do you require the separate purchase of the Elbow Complex? Yes
Broadband or Single Channel? Single Channel
Feed Line Size 4 1/16 inches inches
Side Mount Brackets Do you require the separate purchase of side mount brackets for a high power antenna?
Pattern Scatter Analysis Do you require separate purchase of pattern scatter analysis for a side mount high or medium power antenna? No
Sweep Test Do you require the sweep testing of transmission line and antenna? Yes

Primary Antenna

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Other Antenna Cost Not Listed

Name Description

Antenna Input

Antenna Input

Transmission Line

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Section Question Response
Transmission Line Related Expenses Do you have transmission line related expenses? No

Tower Equipment And Rigging Costs

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Section Question Response
Tower Equipment or Rigging Costs Changes Do you have tower equipment or rigging costs changes? Yes

Primary Tower

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Existing Tower

Section Question Response
Existing Tower Description Type of change Modify Existing
Tower Use Primary (Main)
Description of Use N/A
Ownership Leased
Is this tower consider Complex? No
Is this tower currently shared with any other stations? No
One or more FM, AM or TV radio broadcaster(s) N/A
Others Types of Users N/A
Is tower documented for structural analysis? No
Is tower compliant with Rev G? No
Existing Tower Structure Registration Do you have a tower registration number? Yes
ASR Number 1055244
Coordinates (NAD83) Latitude (NAD83) 41° 10' 58.2" N-
Longitude (NAD83) 075° 52' 11.5" W-
Overall Structure Height 835.95 feet
Support Structure Height 790.67 feet
Ground Elevation Above Mean Sea Level (AMSL) 2117.10 feet
Structure Type TOWER - Free Standing or Guyed Structure
Tower Owner SpectraSite Communications, LLC. through American Towers, LLC.
Date Constructed 07/16/2008


Primary Tower

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Tower Modification Costs

Section Question Response
Engineering Study Please what type of engineering study is required, if any: Study needed for undocumented/poorly documented tower
Tower Reinforcements Please select whether tower reinforcements are needed: Major Reinforcements needed

Primary Tower

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Tower Rigging Costs

Section Question Response
Tower Rigging Costs Complex Tower N/A
Helicopter Services Required Are helicopter services required? No

Primary Tower

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Other Tower Expenses Not Listed

Information not provided.

Outside Professional Services Costs

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Section Question Response
Outside Project Management Services Do you require outside project management services? Yes
Number of Hours 470
Explanation Outside consulting engineering, legal work, and accounting services, as well as project management for regional and comprehensive repack execution.
Outside RF consulting Engineering Services Perform engineering study for new channel assignment and antenna development Yes
Prepare engineering section of Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare engineering section of Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
Do you have Distributed Transmission System engineering services? N/A
Critical Facility N/A
Terrain-Shielded Facility N/A
Attorney and Other Outside Consulting Services Prepare and file Form FCC Construction Permit Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare and file Form FCC License to Cover Application Yes
For Auxiliary Facility No
For Main Facility Yes
Prepare request for Special Temporary Authority Yes
Quantity 2
NEPA Section 106 environmental review Yes
Environmental Assessment Yes
ASR Modification Yes
FAA Consultation (including preparation of FAA Form 7460) Yes
Negotiation of Lease and other Matter for Shared Locations Yes
Prepare or Review FCC Form 399 for Reimbursement Yes
Address transition timing and coordination issues w/ other stations and wireless providers Yes
RF Field Engineering Services Comprehensive coverage verification via field study Yes
RF exposure measurements No
Additional Field Engineering Service No
Number of Days N/A
Justification N/A

Outside Professional Services Costs

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Other Professional Services Expenses Not Listed

Name Description

Sinclair Internal Costs

Internal Employee Time Costs

Other Expenses

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Section Question Response
AM Pattern Disturbance Is an Impact Study needed? No
Is Remediation needed? No
Facility Expenses Name N/A
Other Distributed Transmission System Expenses Not listed N/A
Name N/A
Is Notification of a Medical Facility required as a result of DTV broadcasting? Yes
Permit and Filing Costs Local Zoning Yes
Non-zoning permits Yes
BLM or NFS Coordination No
FCC Construction Permit Minor Change Yes
FCC License to Cover Application Yes
FCC Special Temporary Authority Application Yes
Other Miscellaneous Expenses Does this relocation require paying Disposal Costs (for equipment and other waste, net of any salvage value)? Yes
Does this relocation require Equipment Delivery or Handling Charges not otherwise included in individual item costs? Yes
Does this relocation require Equipment Storage? Yes
Does this relocation require the Development and Airing of an Announcement regarding an upcoming channel change? Yes
Does this relocation require MVPD Notification of a Channel Change? Yes

Other Expenses

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Other Expenses Not Listed

Name Description

True-up

True-up

Cost Information

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Transmitters

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $2,126,655.81 $2,031,470.81 N/A $1,488,318.43 N/A
Total for all systems $3,520,219.91 $3,353,413.83 N/A $2,031,083.91 N/A
Primary Transmitter THU9evo/20 $1,169,255.81 $1,118,555.81 $892,390.93
Installation Materials $7,172.00 $7,172.00 N/A $7,172.00 N/A
UHF inside RF system including switching $204.83 $204.83 N/A $204.83 N/A
Additional Equipment $41,912.98 $41,912.98 N/A $41,912.98 N/A
Transmitter Building $97,966.00 $97,966.00 N/A $97,966.00 Invoice #6861 can be removed.
Transformer 3 phase/480v - 300 KVA $36,800.00 $35,000.00 N/A $25,825.00 N/A
Switchgear - industrial 800 amp $38,200.00 $36,300.00 N/A $0.00 Invoice #6994 can be removed. It has been resubmitted under Transmitter Building.
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $900,000.00 N/A $719,310.12 Invoice #6993 can be removed. It has been resubmitted under Transmitter Building.
Auxiliary Transmitter THU9evo/20 $957,400.00 $912,915.00 $595,927.50
2" Rigid Conduit and Wiring (Cost per foot) $10,400.00 $12,915.00 See Herron Electric Inc invoice #6810 $12,915.00 N/A
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW $947,000.00 $900,000.00 N/A $583,012.50 N/A

Components

Actual Information Description File Name
Installation Materials

Component Description:
Installation materials. #9500127316
Amount:
$7,172.00
UHF inside RF system including switching

Component Description:
Transmitter related cost. #3127822
Amount:
$204.83
Additional Equipment

Component Description:
Additional transmitter parts. #9500111040
Amount:
$13,772.98

Component Description:
Additional transmitter parts. #9500113711
Amount:
$28,140.00

Component Description:
Additional transmitter parts. #9500111040
Amount:
$13,772.98
Transmitter Building

Component Description:
Transmitter building cost. #6993
Amount:
$69,375.00

Component Description:
Transmitter building cost. #6861
Amount:
$63,075.00

Component Description:
Transmitter building cost. #6993
Amount:
$69,375.00

Component Description:
Transmitter building cost. #6994
Amount:
$25,835.00

Component Description:
Transmitter building cost. #178
Amount:
$2,756.00
Transformer 3 phase/480v - 300 KVA

Component Description:
Transmitter related cost. #6811
Amount:
$25,825.00
Switchgear - industrial 800 amp

Component Description:
Transmitter related cost. #6994
Amount:
$25,835.00
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
Transmitter related cost. #3091818
Amount:
$4,397.62

Component Description:
Transmitter related cost. #9500111150
Amount:
$131,900.00

Component Description:
Transmitter related cost 75%. #9500092377
Amount:
$437,259.37

Component Description:
Transmitter related cost. #6993
Amount:
$69,375.00

Component Description:
Resubmitted under UHF inside RF system including switching #3127822
Amount:
N/A

Component Description:
Transmitter related cost 25%. #9500083870
Amount:
$145,753.13
2" Rigid Conduit and Wiring (Cost per foot)

Component Description:
Conduit and wiring associated cost. #6810
Amount:
$12,915.00
UHF - Liquid Cooled Solid State Transmitter 21 - 31 kW

Component Description:
Transmitter related cost 75%. #9500092379
Amount:
$437,259.37

Component Description:
Transmitter related cost 25%. #9500083877
Amount:
$145,753.13

Component Description:
Transmitter related cost 25%. #9500083877
Amount:
$145,753.13

Component Description:
Transmitter related cost 75%. #9500092379
Amount:
$437,259.37

Cost Information

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Antennas

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $309,262.18 $293,962.18 N/A $138,986.82 N/A
Total for all systems $3,520,219.91 $3,353,413.83 N/A $2,031,083.91 N/A
Primary Antenna TFU-18GTH/VP-R 04 $309,262.18 $293,962.18 $138,986.82
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed) $9,570.00 $9,100.00 N/A $6,860.21 Please remove the version of invoice #523022 with the status Need More Information.
Sweep test of existing antenna $6,730.00 $6,400.00 N/A $4,774.40 N/A
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized $289,500.00 $275,000.00 N/A $123,890.03 Please remove the version of invoice #523022 with the status Need More Information.
Antenna Input $3,462.18 $3,462.18 N/A $3,462.18 N/A

Components

Actual Information Description File Name
Elbow complex, single channel, at antenna input, per 4 1/16. feedline (if needed)

Component Description:
Total invoice amount reduced by 25.40%. #529008
Amount:
$851.18

Component Description:
Antenna related cost reduced by 25.40%. #523022
Amount:
$6,009.03

Component Description:
Total invoice amount reduced by 25.40%. #523022
Amount:
$6,009.03
Sweep test of existing antenna

Component Description:
Total invoice amount reduced by 25.40%. #523022
Amount:
$6,009.03

Component Description:
Antenna related cost reduced by 25.40%. #624037
Amount:
$4,774.40
UHF - High Power Top Mount (200-1000 kW), One station antenna , elliptically or circularly polarized

Component Description:
Antenna related cost reduced by 25.40%. #524015
Amount:
$116,259.62

Component Description:
Antenna related cost reduced by 25.40%. #625028
Amount:
$162.96

Component Description:
Antenna related cost reduced by 25.40%. #523022
Amount:
$5,317.86

Component Description:
Total invoice amount reduced by 25.40%. #524015
Amount:
$116,259.62

Component Description:
Total invoice amount reduced by 25.40%. #523022
Amount:
$5,317.86

Component Description:
Total invoice amount reduced by 25.40%. #523022
Amount:
$5,317.86

Component Description:
Total invoice amount reduced by 25.40%. #621026
Amount:
$2,149.59

Component Description:
Antenna related cost reduced by 25.40%. #524015
Amount:
$116,259.62
Antenna Input

Component Description:
Total invoice amount reduced by 25.40%. #559013
Amount:
$3,462.18

Cost Information

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Transmission Line

Information not provided.

Cost Information

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Tower Equipment and Rigging Costs

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $657,800.00 $632,012.00 N/A $281,323.00 N/A
Total for all systems $3,520,219.91 $3,353,413.83 N/A $2,031,083.91 N/A
Primary Tower TOWER $657,800.00 $632,012.00 $281,323.00
Major tower reinforcement/modifications $421,000.00 $400,000.00 N/A $52,475.00 N/A
Tall Tower (greater than 500') $210,500.00 $207,012.00 N/A $207,012.00 N/A
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study $26,300.00 $25,000.00 N/A $21,836.00 N/A

Components

Actual Information Description File Name
Major tower reinforcement/modifications

Component Description:
Tower related cost. #SIN000448
Amount:
$21,000.00

Component Description:
50% invoiced upon order. #E-188490
Amount:
$124,506.00

Component Description:
Tower related cost. #E-188490
Amount:
$21,000.00

Component Description:
Tower reinforcement/modification cost. #160124421
Amount:
$10,475.00
Tall Tower (greater than 500')

Component Description:
Tower related cost. #SIN000448
Amount:
$103,506.00

Component Description:
Tower related cost. #E-188490
Amount:
$103,506.00
Tower mapping for an undocumented/poorly documented tower and preparation of documentation necessary for tower load study

Component Description:
Tower mapping cost. #160124420
Amount:
$21,836.00

Cost Information

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Outside Professional Services

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $220,691.56 $190,763.48 N/A $97,274.83 N/A
Total for all systems $3,520,219.91 $3,353,413.83 N/A $2,031,083.91 N/A
Outside Professional Services $220,691.56 $190,763.48 $97,274.83
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet $10,520.00 $10,000.00 N/A N/A N/A
NEPA Section 106 environmental review, if needed $6,310.00 $6,000.00 N/A N/A N/A
Attorney Fees - Prepare and File request for Special Temporary Authorization $7,360.00 $0.00 N/A N/A N/A
Attorney Fees - Negotiation of lease and other matters for shared locations $4,210.00 $0.00 N/A N/A N/A
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application $2,365.00 $0.00 N/A N/A N/A
Prepare request for Special Temporary Authorization $4,100.00 $3,000.00 N/A N/A N/A
Prepare engineering section of FCC Form 2100 (main), License to Cover Application $1,580.00 $1,500.00 N/A $1,353.75 N/A
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application $3,155.00 $3,000.00 N/A $1,770.00 N/A
Perform engineering study for new channel assignment and antenna development $7,360.00 $7,000.00 N/A $2,985.00 N/A
Address transition timing and coordination issues w/ other stations and wireless $2,630.00 $2,500.00 N/A N/A N/A
Sinclair Internal Costs $541.56 $541.56 N/A $541.56 N/A
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application $5,260.00 $221.92 N/A $221.92 N/A
Project management of the transition $74,260.00 $70,500.00 N/A $60,954.81 N/A
Comprehensive coverage verification via field study, if needed $84,200.00 $80,000.00 N/A $27,000.00 N/A
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase $2,105.00 $2,000.00 N/A N/A N/A
ASR modification (prepare FCC Form 854) $2,105.00 $2,000.00 N/A N/A N/A
Prepare and or review reimbursement form $2,630.00 $2,500.00 N/A $2,447.79 N/A

Components

Actual Information Description File Name
Environmental Assessment, if triggered by NEPA Section 106 review or for certain structures over 450 feet Information not provided.
NEPA Section 106 environmental review, if needed Information not provided.
Attorney Fees - Prepare and File request for Special Temporary Authorization Information not provided.
Attorney Fees - Negotiation of lease and other matters for shared locations Information not provided.
Attorney Fees -Prepare and File FCC Form 2100 (main), License to Cover Application Information not provided.
Prepare request for Special Temporary Authorization Information not provided.
Prepare engineering section of FCC Form 2100 (main), License to Cover Application

Component Description:
Consulting engineering cost. #882-05-0003
Amount:
$1,353.75
Prepare engineering section of FCC Form 2100 (main), Construction Permit Application

Component Description:
Consulting engineering cost
Amount:
$1,770.00
Perform engineering study for new channel assignment and antenna development

Component Description:
Consulting engineering cost
Amount:
$2,985.00
Address transition timing and coordination issues w/ other stations and wireless Information not provided.
Sinclair Internal Costs

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations. #IL-SBG-09012021-LB
Amount:
$10.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$11.03

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 42 stations.
Amount:
$10.78

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 38 stations.
Amount:
$60.06

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$1.69

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 47 stations. #IL-SBG-11012021-SD
Amount:
$6.47

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$33.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$17.02

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 38 stations.
Amount:
$8.19

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 39.39 stations.
Amount:
$39.39

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 46 stations.
Amount:
$1.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 48 stations.
Amount:
$24.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$23.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations. #IL-SBG-09012021-SD
Amount:
$14.26

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$26.93

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$16.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$11.39

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$5.37

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 47 stations. #IL-SBG-10012021-SD
Amount:
$14.16

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$8.66

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$6.09

Component Description:
Portion of general repack matter internal time card attributable to this station - divided by 100.
Amount:
$66.55

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 54 stations.
Amount:
$23.95

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 46 stations.
Amount:
$23.56

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$7.86

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$15.08

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$7.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$9.47

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations.
Amount:
$25.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 54 stations.
Amount:
$8.64
Attorney Fees - Prepare and File FCC Form 2100 (main), Construction Permit Application

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289
Amount:
$122.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759
Amount:
$99.92
Project management of the transition

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #478780
Amount:
$271.41

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1072
Amount:
$237.64

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1069
Amount:
$246.68

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #479285
Amount:
$372.60

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 48 stations. #487892
Amount:
$103.07

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations.
Amount:
$30.47

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #475744
Amount:
$305.99

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472985
Amount:
$282.68

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations.
Amount:
$185.10

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 42 stations. #257
Amount:
$1,209.02

Component Description:
Legal services cost. #474437
Amount:
$57.50

Component Description:
Legal services cost. #475320
Amount:
$326.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$86.88

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$716.28

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 38 stations. #481976
Amount:
$965.23

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #132
Amount:
$589.44

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 40 stations. #328
Amount:
$1,864.33

Component Description:
Legal services cost. #480190
Amount:
$196.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 46 stations. #485240
Amount:
$541.57

Component Description:
Legal services cost. #487919
Amount:
$58.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #474809
Amount:
$395.77

Component Description:
Legal services cost. #485943
Amount:
$50.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1167
Amount:
$313.41

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #107
Amount:
$602.28

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #118
Amount:
$468.97

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 47 stations. #339
Amount:
$1,816.24

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #479829
Amount:
$458.99

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #470923
Amount:
$406.65

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1111
Amount:
$159.58

Component Description:
Legal services cost. #474847
Amount:
$160.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1156
Amount:
$399.52

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1123
Amount:
$342.14

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1133
Amount:
$307.72

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1093
Amount:
$265.72

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #470237
Amount:
$436.37

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1117
Amount:
$282.68

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1143
Amount:
$436.90

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 99 stations. #469573
Amount:
$377.14

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #477305
Amount:
$393.53

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1151
Amount:
$388.07

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1114
Amount:
$242.25

Component Description:
Legal services cost. #473024
Amount:
$115.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 48 stations. #309
Amount:
$1,299.46

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1058
Amount:
$187.24

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$818.59

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 54 stations. #236
Amount:
$1,117.50

Component Description:
Legal services cost. #478299
Amount:
$90.00

Component Description:
Legal services cost. #476915
Amount:
$257.50

Component Description:
Legal services cost. #457871
Amount:
$318.00

Component Description:
Legal services cost. #469529
Amount:
$57.50

Component Description:
Legal services cost. #462925
Amount:
$117.20

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #476367
Amount:
$364.80

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1063
Amount:
$262.29

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$836.44

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1105
Amount:
$216.88

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1090
Amount:
$176.70

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 99 stations. #468718
Amount:
$349.51

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 99 stations. #1086
Amount:
$275.35

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #478288
Amount:
$194.86

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1098
Amount:
$238.07

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472583
Amount:
$279.89

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #465001
Amount:
$596.30

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 42 stations. #485630
Amount:
$405.83

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #464321
Amount:
$683.07

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #471524
Amount:
$322.83

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$20.91

Component Description:
Legal services cost. #479846
Amount:
$172.50

Component Description:
Legal Service Cost. #465215
Amount:
$235.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1079
Amount:
$177.14

Component Description:
Legal services cost. #478803
Amount:
$828.90

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #467378
Amount:
$576.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759
Amount:
$29.98

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$999.04

Component Description:
Legal services cost. #485252
Amount:
$243.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #463567
Amount:
$566.48

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$43.71

Component Description:
Project management cost. #347967
Amount:
$9,480.00

Component Description:
Legal services cost. #477334
Amount:
$1,373.95

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #473506
Amount:
$421.40

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #472173
Amount:
$311.78

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #475283
Amount:
$384.08

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #473885
Amount:
$318.62

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 46 stations. #247
Amount:
$1,105.31

Component Description:
Legal services cost. #472616
Amount:
$332.60

Component Description:
Legal services cost. #475781
Amount:
$316.25

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #465173
Amount:
$654.26

Component Description:
Legal services cost. #484766
Amount:
$183.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1145
Amount:
$369.98

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #477820
Amount:
$320.19

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations.
Amount:
$105.97

Component Description:
Legal Service Cost. #466730
Amount:
$182.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #476885
Amount:
$403.34

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$32.35

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #466690
Amount:
$446.87

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1130
Amount:
$281.49

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1055
Amount:
$243.38

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$20.64

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1161
Amount:
$267.48

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1099
Amount:
$266.93

Component Description:
Legal services cost. #476403
Amount:
$4,540.00

Component Description:
Legal services cost. #473575
Amount:
$102.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #479829
Amount:
$460.71

Component Description:
Legal services cost. #481915
Amount:
$171.25

Component Description:
Legal services cost. #464339
Amount:
$62.50

Component Description:
$26,919.78 credit to be split across 93 Sinclair stations reimbursed $999.20 for Invoice 461759 (correct reimbursement amount is $709.74). #CM-11-21-2019-461759
Amount:
($289.46)

Component Description:
Legal services cost. #477849
Amount:
$1,133.75

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #480175
Amount:
$377.96

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 38 stations.
Amount:
$1,374.71

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$943.95

Component Description:
Legal services cost. #460961
Amount:
$190.00

Component Description:
Legal Service Cost. #467882
Amount:
$120.00

Component Description:
Legal services cost. #473920
Amount:
$320.00

Component Description:
Legal services cost. #471561
Amount:
$327.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #467861
Amount:
$470.30

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #463026
Amount:
$801.57

Component Description:
Legal services cost. #470261
Amount:
$455.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #474405
Amount:
$490.56

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 100 stations. #1141
Amount:
$406.17

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289
Amount:
$91.50

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #1078
Amount:
$215.68
Comprehensive coverage verification via field study, if needed

Component Description:
Outside service cost. #207007
Amount:
$27,000.00
FAA consultant, including cost of preparing FAA Form 7460 (Notice of Proposed Construction), if needed for height increase Information not provided.
ASR modification (prepare FCC Form 854) Information not provided.
Prepare and or review reimbursement form

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 98 stations. #461759
Amount:
$869.30

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations.
Amount:
$152.01

Component Description:
Legal services cost.
Amount:
$115.00

Component Description:
Portion of general repack matter invoice attributable to this station - divided by 93 stations. #461289
Amount:
$1,311.48

Cost Information

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Other Expenses

Where no predetermined cost estimate is available, any estimate provided will also become the predetermined cost (displayed in italics).
Description Predetermined
Cost Estimate
Estimated Cost Estimated Cost Justification Actual Cost Actual Cost Justification
Sub-total $205,810.36 $205,205.36 N/A $25,180.83 N/A
Total for all systems $3,520,219.91 $3,353,413.83 N/A $2,031,083.91 N/A
Other Expenses $205,810.36 $205,205.36 $25,180.83
MVPD Notification of Channel Change $5,000.00 $5,000.00 See Exhibit J. N/A N/A
Develop and air announcement of upcoming channel change $75,000.00 $75,000.00 See Exhibit J. N/A N/A
Equipment Storage $15,000.00 $15,000.00 See Exhibit J. $3,755.00 N/A
Equipment Delivery and Handling Charges $17,620.36 $17,620.36 See Exhibit J. $17,620.36 N/A
Disposal Costs (for equipment and other waste, net of any salvage value) $50,000.00 $50,000.00 See Exhibit J. $11,523.02 N/A
Non-zoning permits $10,000.00 $10,000.00 See Exhibit J. N/A N/A
True-up $0.00 $0.00 N/A ($12,217.55) N/A
DTV Medical Facility Notification $11,550.00 $11,000.00 N/A $3,750.00 N/A
FCC Filing Fees - Form 2100 minor change CP application $1,110.00 $1,070.00 N/A N/A N/A
FCC Filing Fees - Form 2100 license to cover application $335.00 $325.00 N/A N/A N/A
FCC Filing Fees - Special Temporary Authorization request $195.00 $190.00 N/A N/A N/A
Local Zoning $20,000.00 $20,000.00 See Exhibit J. $750.00 N/A

Components

Actual Information Description File Name
MVPD Notification of Channel Change Information not provided.
Develop and air announcement of upcoming channel change Information not provided.
Equipment Storage

Component Description:
Equipment storage cost. #6380
Amount:
$300.00

Component Description:
Equipment storage cost. #6230
Amount:
$300.00

Component Description:
Equipment storage cost. #6305
Amount:
$300.00

Component Description:
Equipment storage cost. #5900
Amount:
$300.00

Component Description:
Equipment storage cost. #6157
Amount:
$300.00

Component Description:
Equipment storage cost. #5720
Amount:
$300.00

Component Description:
Equipment storage cost. #6042
Amount:
$300.00

Component Description:
Equipment storage cost. #5985
Amount:
$300.00

Component Description:
Equipment storage cost. #6098
Amount:
$300.00

Component Description:
Equipment storage cost. #5641
Amount:
$300.00

Component Description:
Equipment storage cost. #5640
Amount:
$455.00

Component Description:
Equipment storage cost. #5817
Amount:
$300.00

Component Description:
Total invoice amount reduced by 25.40%. #566001
Amount:
$2,693.75
Equipment Delivery and Handling Charges

Component Description:
Total invoice amount reduced by 25.40%. #566001
Amount:
$780.50

Component Description:
Total invoice amount reduced by 25.40%. #532008
Amount:
$517.44

Component Description:
Equipment delivery cost. #6279
Amount:
$965.00

Component Description:
Equipment delivery cost. #6286
Amount:
$416.00

Component Description:
Equipment storage cost. #6427
Amount:
$6,488.87

Component Description:
Total invoice amount reduced by 25.40%. #566001
Amount:
$780.50

Component Description:
Equipment delivery and handling cost reduced by 25.40%. #623034
Amount:
$1,946.20

Component Description:
Equipment delivery cost. #6280
Amount:
$791.00

Component Description:
Total invoice amount reduced by 25.40%. #563050
Amount:
$2,440.35

Component Description:
Equipment delivery cost. #6250
Amount:
$2,300.00

Component Description:
Invoice #6427 credit memo. #6553
Amount:
($30.00)

Component Description:
Equipment handling cost. #6284
Amount:
$1,005.00
Disposal Costs (for equipment and other waste, net of any salvage value)

Component Description:
Disposal cost. #220
Amount:
$7,488.90

Component Description:
Disposal cost. #2828031-0821-0
Amount:
$659.43

Component Description:
Disposal cost. #2811694-0821-4
Amount:
$122.06

Component Description:
Disposal cost. #2827145-0821-9
Amount:
$376.35

Component Description:
Disposal cost. #2824340-0821-9
Amount:
$122.06

Component Description:
Disposal cost. #2786692-0821-9
Amount:
$578.14

Component Description:
Disposal cost #2785737-0821-3
Amount:
$262.56

Component Description:
Disposal cost. #2809308-0821-5
Amount:
$428.26

Component Description:
Disposal cost. #2810556-0821-6
Amount:
$138.57

Component Description:
Disposal cost. #2814807-0821-9
Amount:
$122.06

Component Description:
Disposal cost. #2797959-0821-9
Amount:
$187.66

Component Description:
Disposal cost. #2822779-0821-0
Amount:
$138.57

Component Description:
Disposal cost. #2815837-0821-5
Amount:
$72.56

Component Description:
Disposal cost. #2792345-0821-6
Amount:
$393.32

Component Description:
Disposal cost. #2828167-0821-2
Amount:
$6.50

Component Description:
Disposal cost. #2796613-0821-3
Amount:
$326.85

Component Description:
Disposal cost. #2821881-0821-5
Amount:
$105.67

Component Description:
Disposal cost. #2828436-0821-1
Amount:
$6.50
Non-zoning permits Information not provided.
True-up

Component Description:
Dielectric true up. #CM-2021-10-14-WOLF
Amount:
($12,217.55)
DTV Medical Facility Notification

Component Description:
Medical notification cost. #1163
Amount:
$3,750.00
FCC Filing Fees - Form 2100 minor change CP application Information not provided.
FCC Filing Fees - Form 2100 license to cover application Information not provided.
FCC Filing Fees - Special Temporary Authorization request Information not provided.
Local Zoning

Component Description:
Zoning cost. #377990
Amount:
$750.00

Cost Information

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Grand Total

Predetermined
Cost Estimate
Estimated Cost Actual Cost
Total for all systems $3,520,219.91 $3,353,413.83 $2,031,083.91

Reimbursement Status

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Question Response
The facility has ceased operating on its pre-auction channel. No
Construction of final facilities or all necessary modifications are complete. No
All receipts for reimbursement have been submitted no further costs are expected to be incurred. Note this will lock the Form 399 from further editing and begin close-out procedures with the Fund Administrator. No

Certification

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Section Question Response
Submission of Estimated Expenses Statements

WILLFUL FALSE STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT.

  1. The Authorized Person signing below certifies that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.

  2. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

  3. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  4. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (broadcasters) or to continue to carry the signal of a broadcaster that changes channels (MVPD).

  5. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.

  6. The above-named entity certifies that it will maintain and provide to the Commission detailed records, including receipts, of all costs eligible for reimbursement actually incurred.

  7. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  8. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a pre-requisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

John Parente

President


02/08/2022

Certification

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Section Question Response
Submission of Actual Cost Documentation Statements

WILLFUL FALSE, FRAUDULENT, OR FICTITIOUS STATEMENTS ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISIONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503), AND ANY FALSE AND/OR FRAUDULENT STATEMENTS COULD SUBJECT THIS ENTITY TO LIABILITY UNDER THE FALSE CLAIMS ACT (U.S. CODE, TITLE 31, SECTIONS 3729-3733).

  1. The Authorized Person signing below certifies and represents that he/she is authorized to submit this TV Broadcaster Relocation Fund Reimbursement Form on behalf of the above-named entity.

  2. The above-named entity certifies that the statements in this form and attached documentation are true, complete, and correct.

  3. The above-named entity acknowledges that all certifications and attached documentation are considered material representations.

  4. The above-named entity acknowledges the submission of the information herein creates no obligation on the part of the government to pay any amount.

  5. The above-named entity certifies that the equipment and services paid for with money from the TV Broadcaster Relocation Fund are necessary to change channels (full power and Class A stations) and/or otherwise modify a television station’s facility as a result of the spectrum repack (LPTV/TV Translator stations); or to minimize service disruption resulting from a repacked television station (FM stations); or to continue to carry the signal of a broadcaster that changes channels (MVPD) .

  6. The above-named entity certifies that all payments from the TV Broadcaster Relocation Fund (Fund) received by the entity listed on this form will be used only for expenses that are eligible for reimbursement from the Fund.

  7. The above-named entity certifies that the cost information/documents submitted reflect costs actually incurred.

  8. The above-named entity acknowledges that overpayments or payments in error must be promptly refunded to the Commission.

  9. The above-named entity certifies that it is in full compliance with all statutes, rules, regulations and governmental requirements for which compliance is a prerequisite for obtaining the payments herein requested.

I declare, under penalty of perjury, that I am an authorized representative of the above-named applicant for the Authorization(s) specified above.

John Parente

President


02/08/2022

Attachments

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